Critics say flu plan places too much burden on state, local agencies

WASHINGTON—One day after President Bush outlined a national strategy to fight a global flu pandemic, new concerns are emerging that state and local health agencies can't afford flu-fighting medications or provide the services that would be needed if there were an outbreak of deadly avian flu.

The early discord over federal assistance with local flu planning suggests that the president's request for $7.1 billion in emergency flu preparedness funds might face a tougher battle in Congress than expected.

The president's flu plan calls for states collectively to stockpile enough anti-viral medication to treat 31 million people. States would pay 75 percent of the cost—or an estimated $500 million—while the federal government would pay 25 percent.

But as states struggle with slow revenue growth, rising Medicaid costs and recovery from Hurricane Katrina, lawmakers on Capitol Hill are wondering where the money will come from.

"How are you going to ask Louisiana right now to come up with money for that? Take Mississippi. I mean, they've been hit hard. ... Other states are having problems, too," Sen. Tom Harkin, D-Iowa, told Health and Human Services Secretary Michael Leavitt in a flu preparedness hearing Wednesday before a subcommittee of the Senate Appropriations Committee.

Sen. Patty Murray, D-Wash., expressed similar concerns, noting that the president's 2006 budget calls for cuts of $130 million in funding for state and local health departments.

"They are already struggling," Murray said. "So if we add this on top of them and say, `If you want to participate, come up with 75 percent of the funding,' we are going to have a public health crisis. And that concerns me greatly."

Leavitt said that public health is a state and local responsibility and that cost sharing for anti-viral medications was a reasonable way for the federal government to help.

"We want to make certain that they are buying into pandemic preparation and not just looking for a check from the federal government to put into a federal stockpile," Leavitt said.

Later, Leavitt said that communities have to be responsible for public health because they're all different. "The role of the national government is to assist them in meeting that obligation," he said.

The federal government is already helping states and communities prepare for a pandemic by providing such things as lab training and equipment and virus surveillance expertise.

The Department of Health and Human Services released a 400-page "Pandemic Influenza Plan," which details the services and responsibilities of local health agencies in the event of a pandemic.

It makes clear that state and local health departments will bear the brunt of flu response. They must handle local surveillance, identify influenza strains, develop intervention strategies, monitor hospital admissions, implement disease control measures and provide updated information to the public.

"The final responsibility for oversight of the distribution of medication and supplies will rest with state and local public health departments, and many simply do not have the necessary resources," said Mike Crutcher, Oklahoma Commissioner of Health.

The long-awaited plan estimates that, in a worst-case scenario, 1.9 million people could die in a flu pandemic. Nearly 10 million would require hospitalization and another 45 million would seek outpatient care.

The potent avian, or bird, flu virus is constantly evolving, and scientists warn that while it is largely limited to birds, it could mutate into a form that is highly contagious among human beings. Death rates could be high because people would have no immunity.

The plan says anti-viral medications should be given first to hospital patients, health care workers, public safety workers and "high risk" people such as the elderly and pregnant women. Vaccines would go first to workers at plants that make the vaccines, medical and public health workers, and people who live with those with weak immune systems.

But it provides only $100 million to help state and local governments prepare for a pandemic.

Dr. George Hardy, executive director of the Association of State and Territorial Health Officials, said he would work with Congress and the White House to secure more federal assistance.

If a pandemic flu does strike, states could find themselves making emergency program cuts. "From where we sit, they will probably have to take it out of other public health programs," said Patrick Libby, executive director of the National Association of County and City Health Officials.

He said federal officials don't seem to understand the level of burden that a flu pandemic would place on states.

"It just appears to be a lack of understanding or a lack of a clear connection between what's expected and the ability to pay for it," Libby said.

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To see the HHS pandemic influenza plan, go to www.pandemicflu.gov. A link to it is under the "Highlights" section.

For a look at state pandemic flu plans, go to the Council of State and Territorial Epidemiologists Web site at www.cste.org/specialprojects/Influenzaplans/StateMap.asp